123I-IBZM binding compared with long-term clinical follow up in patients with de novo parkinsonism.
We performed a prospective clinical follow up (mean follow up, 36 months; range, 24-56 months) of 65 patients with de novo parkinsonism in whom imaging of dopamine D2 receptors was performed before the initiation of dopaminomimetic therapy by means of 123I-iodobenzamide-single-photon-emission computed tomography (IBZM-SPECT). The results of IBZM-SPECT were compared with the long-term response to dopaminomimetic drugs, the development of motor fluctuations, and the development of clinical signs incompatible with Parkinson's disease (PD). A total of 55 patients had normal and 10 patients had reduced IBZM binding; 45 patients showed a good response to levodopa (L-dopa), 11 showed an equivocal response, and nine did not respond; 31 patients developed a fluctuating response to dopaminomimetic drugs and seven patients developed clinical signs indicative of multiple-system atrophy (n = 5), progressive supranuclear palsy (n = 1), or corticobasal ganglionic degeneration (n = 1). Chi-squared analysis showed a significant correlation of the results of IBZM-SPECT with the long-term response to dopaminomimetic therapy (p < 0.0001) and the development of motor fluctuations (p < 0.001) or clinical signs incompatible with PD (p < 0.0001). We conclude that IBZM-SPECT can help to differentiate between patients who will show a good response to L-dopa and will develop motor fluctuations (most likely patients with PD) and those patients who will not respond to L-dopa and might develop clinical signs compatible with another hypokinetic disorder of the basal ganglia.
Schwarz
J
J
Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Tatsch
K
K
Gasser
T
T
Arnold
G
G
Pogarell
O
O
Künig
G
G
Oertel
W H
WH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001058:Apomorphine; D001480:Basal Ganglia Diseases / Q000188:drug therapy / Q000378:metabolism; D001549:Benzamides / Q000378:metabolism*; D016009:Chi-Square Distribution; D018450:Disease Progression; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000378:metabolism; D007980:Levodopa / Q000627:therapeutic use*; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D001549:Benzamides; D018491:Dopamine Agonists; D007457:Iodine Radioisotopes; D007980:Levodopa; D001058:Apomorphine